Polio Eradication Initiative: Progress 1988-2011

1988 350,000 cases 125 countries

2011* 627 cases 4 endemic countries 12 re-infected countries

*Data as of 10 Jan 2012

Global Polio Cases 2010-2011 Country 2010 2011

Pakistan Chad DRC Afghanistan Nigeria Cte d'Ivoire China Mali Angola Niger CAR Guinea India Congo Kenya Gabon Tajikastan Senegal Russian Federation Others Total 144 26 100 25 21 0 0 4 33 2 0 0 42 441 0 0 460 18 14 22 1352 192 130 92 76 52 36 21 7 5 5 4 3 1 1 1 1 0 0 0 0 627

Current Status: Polio-infected districts, last 6 Months

Smallest type 3 infected area & cases in history

India: 10 months with no polio case for 1st time in history!

28 Jun 27 Dec 2011

Major risk : ongoing outbreaks in neighbouring & other countries ! Virus can always return !

wild virus type 1 wild virus type 3

Response to cases in neighbouring countries

JAMMU & KASHMIR

5 States that share a border with China & Pakistan alerted Intensification of surveillance in border districts and areas with significant population movement in 5 states Rapid Response Team members deployed Continuous vaccination at border posts with significant movement across the border

HIMACHAL PRADESH PUNJAB

CHANDIGARH
UTTARAKHAND

HARYANA DELHI

UTTAR PRADESH RAJASTHAN BIHAR

JHARKHAND GUJARAT MADHYA PRADESH CHHATTISGARH

Continous immunization to protect our borders State District Start Vaccination Point Punjab Amritsar 15/09/2011 Attari Railway Station Punjab Amritsar 12/9/2011 Wagah Border Rajasthan Barmer 8/10/2011 ManuaBao Railway Station Jammu & Kashmir Poonch 10/9/2011 Chak Da Bagh Jammu & Kashmir Baramula Oct-11 Kaman PHC Ishm

* data as on 3 July 2010

Continuous vaccination along Indo-Nepal border

Vaccination post
Blocks with vaccination post

NEPAL

Uttar Pradesh

INDIA
Bihar
81 vaccination posts

~ 1.3 million children vaccinated (April to December 2011)

Polio Situation in India

2000

1 case to date in 2011 vs 42 cases in 2010.

1750 1500 1250 1000
741
P2 virus eradicated

1 serotype in 2011 vs 2 in 2010. 1 genetic cluster in 2011 vs 5 in 2010.

750 500
bOPV introduced in January 2010

250
42 1

0 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011*

P1 wild
* data as on 2 January 2012

P3 wild

Location of wild poliovirus cases by type, 2010 & 2011*

West Bengal was the only state with WPV in 2011

WPVs - 2010 State West Bengal Maharashtra Bihar Jharkhand Jammu & Kashmir Uttar Pradesh Haryana Total P1 6 5 3 3 1 0 0 18 P3 2 0 6 5 0 10 1 24 Total 8 5 9 8 1 10 1 42
Total State West Bengal

WPVs - 2011* P1 1 1 P3 Total 1 1

* data as on 2 January 2012

Weekly incidence of WPV cases, India, 2009 11

40

WPV 1 No WPV1 for last 11 months

32

24

16

11

13

15

17

19

21

23

25

27

29

31

33

35

37

39

41

43

45

47

49

51

11

13

15

17

19

21

23

25

27

29

31

33

35

37

39

41

43

45

47

49

51

11

13

15

17

19

21

23

25

27

29

31

33

35

37

39

41

43

45

Jan

Feb

Mar Apr

May

Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan

Feb

Mar Apr

May Jun

Jul

Aug

Sep

Oct

Nov

Dec

Jan Feb Mar

Apr

May

Jun

Jul

Aug

Sep

Oct

40

WPV 3 No WPV3 for last 14 months

32

24

16

Longest polio free period historically

1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45 47 49 51 1 3 5 7 9 11 13 15 17 19 21 23 25 27 29 31 33 35 37 39 41 43 45

Jan Feb Mar Apr

May Jun Jul Aug

Sep Oct Nov Dec

Jan Feb Mar Apr May Jun

Jul

Aug Sep Oct Nov Dec

Jan Feb Mar

Apr May

Jun

Jul

Aug

Sep

Oct

2009
* data as on 2 January 2012

2010

2011*

Progress in UP & Bihar

60

UP
50 40

WPV1

WPV3

Most recent WPV1: Nov 09 Most recent WPV3: Apr 10

30 20

10

0
Nov D ec Jan F eb M ar Apr M ay Jun Jul A ug S ep O ct Nov D ec Jan F eb M ar Apr M ay Jun Jul A ug S ep O ct

60

Bihar
50 40

Most recent WPV1: Sep 10 Most recent WPV3: Jan 10

30

20

10

0
N ov D ec Jan F eb M ar A pr M ay Jun Jul A ug S ep O ct N ov D ec Jan F eb M ar A pr M ay Jun Jul A ug S ep O ct

2009
* data as on 24 December 2011

2010

2011*

Wild poliovirus detected in sewage samples, 2010 - 2011

2010
Mumbai Mumbai
Week F ward G ward M ward 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 X X X X X

Delhi Delhi
Week Red cross hospital Bhalaswa lake Wazirpur JJ colony Swarn cinema Batala house (Okhla) 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 X X X X X X X X X X X X X X X X

Mumbai Mumbai
Week F ward 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52

2011*

G ward M ward

Delhi Delhi
Week Red cross hospital Bhalaswa lake Wazirpur JJ colony Swarn cinema 1 X X X X X X X X X X X 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 X X X X X X X X X X X X X X X X X X X X X

Sewage sampling across Mumbai, Delhi identified P1 & P3 circulation is at very low levels in 2010. Last sewage virus isolated in November 2010 in Mumbai
Batala house (Okhla) Sonia vihar Nangloi X X X X X X X X

Patna Patna
Week Choti pahari Dujara Transport nagar 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52

Wild poliovirus type 1 Wild poliovirus type 3 * data as on 24 December 2011

Negative for wild poliovirus Result pending

Scheduled but sample not collected Sampling not scheduled

Summary of Epidemiology
Country at historic low transmission levels Simultaneous progress in both endemic states of UP and Bihar Transmission in West Bengal effectively contained following aggressive mop ups Genetic & environmental surveillance confirms progress

Risks to Polio Eradication in India - II

Introduction and survival of poliovirus in areas with low population immunity and/or other transmission risk factors outside UP and Bihar Gaps in AFP surveillance or delays in detection of WPV Delayed and/or inadequate response to importation

Risk from WPV remains several instances of WPV being detected after 12-18 months in the past

Surveillance performance indicators 2011*

Non-polio AFP rate Stool collection rate

12.20

84%

India Less than 60% 60% to 69% 70% to 79% 80% and above No AFP case
* data as on 7 January 2012

Identification of High Risk Areas, Andhra Pradesh

Migrant sites

High risk areas in settled population

= 1 Migrant site

= 1 HR site 892 HR areas in settled population

5,106 Migrant sites

Percent children found unimmunized in migratory population sites Jan 2011 Feb 2011

Mitigating risks to polio eradication

Emergency Preparedness and Response Plan
 Identify and consistently cover areas and populations at high risk for importation and spread of poliovirus by:

High quality NID

Intensify Routine Immunization

Surveillance

Identify High Risk Areas

Areas at a higher risk of wild polio virus transmission

Migratory
Responsible for importations of WPVs Capable of sustaining low level transmission and moving virus back and forth Poorly covered in RI & SIAs

Non migratory or settled population

Risk of WPV transmission and spread following importation high
Malegaon, Murshidabad & Pakur etc

Poor RI coverage with variable SIA coverage

Identification of High Risk Areas, India, November 2011

Migrant sites

High risk areas in settled population

Ensure identification of all HRAs 4 weeks before Feb NID

= 10 Migrant sites

= 10 HR sites

~ 162,000 Migrant sites

~ 64,000 HR areas in settled population

Migratory High Risk Areas/ Populations 1. Slums

Urban/peri-urban/ Agricultural & Industrial slums

2. Brick Kilns
Children at the labor camps in the brick kilns as well as the pather fields where the bricks are prepared.

Migratory High Risk Areas/ Populations 3. Construction Sites

Children in labor camps at or nearby construction sites, in brick sheds, and in under construction buildings

4. Nomads
Communities who travel from place to place for livelihoods setting up temporary home (dera s) on empty tracks of land near railway stations, market places etc. Often work as blacksmiths, basket weavers, puppeteers, acrobats, fortunetellers, singers and dancers.

5. Others
Migratory fishing communities River islands

Migratory population sites

Slums with migration Nomads Brick kilns Construction site Others

Districts with high migration

High risk areas likely for poliovirus importation

Criteria for selecting districtricts

Analysis was conducted to identify blocks at higher risk of Polio importation as per a scoring scheme developed. Polio compatibles, AFP rate in the current year, Silent blocks (blocks not reporting any AFP cases in the current year), Stool collection rate in the current year SIA indicator such as pocket of refusal (1 cluster - > 50 houses) High risk population (Migratory & Non migratory settled population) Confirmed measles outbreaks, Immunization status of AFP cases Water and sanitation indicator (isolation of NPEV in stool samples of AFP cases).

Blocks likely for polio importation

How should we focus on these areas? What should we do differently in these areas?

Ensuring the best possible preparedness in high risk areas

Identification & Field validation of HRAs
To ensure no HRA is missed during SIAs Get accurate information on location, size, population characteristics etc Determine if the HRA is covered under RI & SIA microplans Identify potential informers for AFP surveillance Identify potential vaccinators, influencers, etc Select appropriate booth & transit site locations

Ensuring the best possible micro plans in HRAs for SIAs & Routine Immunization
Get the basics right
Systematic inclusion of all areas likely to get missed (example: slums, brick kilns, construction sites, nomads) through interaction with vaccinators, supervisors, MOs and field visits Team composition target: 100% teams have appropriate composition; involvement of ASHA/Anganwadi Workers Team workload target: 100% teams have manageable workload Rationalize the transit sites and manpower at these sites

Achieve high quality training for vaccinators of high risk areas

Decentralize the training venues Use training module plan innovations, keep trainings participative
 Role plays : How to enter houses and initiate dialogue & FAQs  Exercises on vaccine administration, Tally sheet filling, house marking  Demonstration of VVM, Finger marking

Enlist support of best trainers during training Monitor and track training attendance and ensure catch up sessions for absentees

Decentralized participatory trainings

Ensuring best possible social mobilization / IEC in HRAs

Implement plans for social mobilization and IEC
Intensive pre-round and during round miking Involvement of community leaders, panchayat members, religious leaders, local practitioners, traditional birth attendants, local teachers, etc Rallies Display of posters, banners etc Media management Programme launch

Ensure high quality & greater quantity of monitoring in HRAs

Intensive monitoring of special sites field huts, HRAs migratory & settled, transit sites Evening meeting at block every day in HR block Block Task Force meetings Identify and prioritize issues for discussion during evening meetings/BLTFs/DTFs

Your presence at block and sub-block level guarantees better activity in HR blocks/areas

Meticulous tracking of performance in these areas

Tracking coverage indicators
houses visited, children vaccinated, newborns identified, newborns vaccinated X houses generated, converted & remaining by category

Tracking monitoring indicators

houses/ field huts / areas missed by teams children missed Weak teams and supervisors

Raising issues during DTF/evening meetings

Feedback on high risk blocks separately

Should we forget the HRAs after NIDs ?

NO !!!!!

Using information from Polio microplans for updating RI microplans to ensure all populations are covered
Block/ PHC/ Urban area: Sarrorpur Name of MOIC: Dr Rakesh Chandra Team No
Name of team members
Designation

Name of Supervisor: Rajbir Singh Sector Incharge: Dr Vinod Kumar Day 1 Description of the area to be covered
Category of area (MATD/ HRA/HRG - Nomad,
Brick kiln, Construction Site, Temporary Slums, Permanent Slums, USC)

Round: November 2011 Day 3

Village Harra HRA Barber Naffees chowk bazar Via Primary School & house of Gazi Dr Idris near bada Madarsa 73 Goodwin Public School Zaibunisha Angaawadi Worker Dr Imran Clinic of Dr Imran Tabbasum (UNICEF) Zaibunisha Angaawadi Worker Soket Kotedar Clinic of Dr Imran Tabbasum (UNICEF)

Day 2
Village Harra HRA Md Naseem s/o Salman Via House of Gaffar near chotti Masjid Kallan dhobi near pond 86

Day 4
Village Harra HRA Sadiq Ali s/o Ikram Gotka road Via house of Md Qadir & Suleman Kaim s/o Anwar ali near small Masjid 98

Day 5
Village Harra HRA Shawar s/o Kazmi near Masjid Via Mukiya house Sharik s/o Razzaq near Post office 100

Village Harra HRA Muglis/ s/o Kallan Binauli road Via village Panchayat Ghar Ajam s/o Sharrudin, Alipura 97 Islamia Madarsa

Mrs Brijesh

ANM

Name & address of first house owner with landmarks Special landmarks in the area & detailed route description (via) Name & address of last house owner with landmarks No of houses in the area Names of schools/ madarsas in the area Name of local third team member

44

Mohd Rizwan

Volunteer Name of local influencer(s) Meeting point before afternoon activity Name of CMC (with agency)

Zaibunisha Angaawadi Zaibunisha Angaawadi Zaibunisha Angaawadi Worker Worker Worker Irfan House of Mr Rakesh (teacher) Tabbasum (UNICEF) Dr Imran House of Mr Rakesh (teacher) Tabbasum (UNICEF) Dr Annes Clinic of Dr Imran Tabbasum (UNICEF)

Microplan for Routine Immunization in the area

1 2 3 4 5 6 7 8 9 Name of Sub centre Name of A.N.M Address of session site RI Session day Name of ASHA (for the session) Name of mobilizer (for the session) Name of anganwadi Worker Name of anganwadi Helper Name of health supervisor
Harra Sub Centre Kamlesh Sharma Harra Sub Centre II Wednesday & IV Saturday Ms Baby Ms Zaibunisha Lilawati Rajbir Singh Harra Sub Centre Brijesh Goodwin Public School Harra Sub Centre Brijesh Manjoor Tokedar Harra Sub Centre Brijesh Community Hall of Tahir Patwari IV Wednesday Ms Reshma Ms Nazma Mantasha Rajbir Singh Harra Sub Centre Brijesh Dairy of Deenma

II Wednesday Ms Baby Ms Zaibunisha Lilawati Rajbir Singh

IV Saturday Ms Reshma Ms Nazma Mantasha Rajbir Singh

I Wednesday Ms Reshma Ms Nazma Mantasha Rajbir Singh

Summary
The high risk approach involves identification of the high areas accurately and then focusing on these areas The approach involves increased human resource presence for better planning, training, monitoring & tracking in the high risk areas It is critical to adopt this approach to ensure consolidate polio eradication and mitigate risks

23 IEAG : Conclusions

India is definitely on the right path to finish eradication.

HOWEVER, a more aggressive approach is essential to manage the risks along this path!
All HRAs to be part of Microplan! All Under5 children to be immunized!

Towards a polio-free India

Rukhsar. Let's ensure she is the last polio case in India!

Its time to create history!

Micro plan review and revision Basic principles

Micro plans must be reviewed at PHC before submission to district Use data generated from previous rounds to revise/ update/ improve existing micro plans instead of starting afresh MO s of planning unit must involve supervisors and vaccinators in the review of microplans Micro plans submitted to district must be reviewed by concerned SPHO, Programme Officer & DIO; findings & corrective actions must be discussed in first DTF
40

Micro plan review and revision Data/Information required

Name of villages and their hamlets/ urban mohallas/ localities- up date lists from census, revenue records, local municipal body, elected representatives, vaccinators & supervisors List of booths in the area and existing microplans for h-t-h visits along with their maps (Form 4 A & B), transit sites, important Melas & congregations List of high risk areas (Migratory & Settled) Department wise list of available vaccinators and supervisors List of Anganwadi, ASHA or community link workers Available cold chain equipment & logistics
41

Review and revision of microplans

Booth microplans House to House activity microplans Microplans for Transit sites & special areas Cold chain and logistics microplans IEC /Social Mobilization microplans
42

Booth Microplans

43

Booth Microplans
Is the number of booths adequate ?
Are they catering to a manageable number of children ? 1 booth for every 250 children in general Number of booths could vary depending on density of population and terrain Smaller villages may have booths with 2 vaccinators

Have booth locations been properly identified ?

Have booth sites been selected to ensure easy reach and are located in sites such as Community centres / schools/ Anganwadi centres that are acceptable to all sections of the society ? Are they geographically distributed to cover all areas ? (Plot all booth locations on maps )

44

Improving Quality of Booth Activities (1)

Booth timings
Booth should start functioning from early in the morning and close late evening

Vaccinators, Anganwadi, ASHA workers, volunteers & school children to mobilize children to the booth
Should not wait till late afternoon

Avoid unnecessary recording of information

45

Improving Quality of Booth Activities (2)

Involve community/religious leaders - to inaugurate booths IEC for Booths
Health workers to meet village/local leaders/ religious leaders to inform about booth locations and day of booth activity Proper visibility of booths through prominent display of banners and posters a week before NID Miking to continue throughout the booth day also
46

House-to-house Microplans

47

Improving quality of House-to-House activity (1) Issues: Are all areas included in h-t-h microplans? Were missed areas detected during previous SIAs?

Actions : Use data from census, revenue, local municipal body, elected representatives to ensure all areas included Supervisors/Vaccinators to walk through areas during planning phase and field validate Proper area allocation to teams with clear cut demarcation Mapping of all areas Border area meetings to synchronize activities along borders All teams must carry copies of Microplans and maps during activity
48

Improving quality of House-to-House activity (2)

Well defined start & end points with landmarks and rational workload up to 125 houses/ day ; < 100 houses in all HRAs Write number of houses covered by each team each day in format below Identify teams with irrational workloads high or low
Tally sheet analysis
Team no. Day 1 Houses visited Day 2 Day 3 Day 4 Day 5

Actions Reduce workload of teams that have to cover more than 125 houses in a day Redistribute workload or increase number of teams in areas with high workload

Note: Analyze the data of last SIA

49

Improving quality of House-to-House activity (3)

Selection of manpower
Accountable female vaccinators from ANMs, Anganwadi & ASHA preferred If AWW/ASHA are not part of hth team they must accompany the team in their village and assist in mobilization & ensure complete coverage At least one female vaccinator from the locally predominant community in HRA Local influencers to accompany teams to all X houses during revisits in areas with mobilization issues Community / religious leaders / economic /medical / dai Panchayati Raj : Pradhan, Panchayat Secretary, Ration Dealers, Lekhpal
50

Improving quality of House-to-House activity (4) Issues

Are teams generating X houses? What is their number? Is there a plan to revisit all X houses?

Actions
If poor X house generation identify such teams and address in trainings If poor X to P conversions, identify reasons
What is the plan to revisit all X houses? Are revisit timings appropriate? Are influencers accompanying teams wherever required?

51

Use Template for Identifying Supervisors & Team areas within blocks requiring interventions
Name of Supervisor No of houses visited by teams No of children immunized by teams % X houses generated by teams % remaining X houses at end of activity % False P houses Any operational problems

52

Microplans for transit sites and special areas

53

Transit & Congregation site microplans

List all transit points and congregation sites
Important Railway stations, bus stands, markets, haats, weekly bazaars, Doctors Clinics Develop local event calendar & ensure coverage of congregations till they continue

Plan to cover all days of SIA activity Physically visit each site to decide the placement, number of vaccinators/ supervisors & shifts
Shifts to coincide with timing of population movement Multiple shifts / round the clock shifts wherever required Develop maps clearly indicating the entry/ exit points and placement of vaccinators Consult authorities/timetables to cover peak periods
54

Improving quality of Transit site activity

Is the selected manpower appropriate ? (energetic)

Has help been sought from NCC & NSS?

Is there a plan for a separate training of all transit team members? Are logistics being provided to vaccinators to work independently? Have frequent supervisory visits been planned to transit sites? Have coordination mechanisms been established with railways/ roadways?
55

Plans for Special areas

List all slums, nomadic sites, construction sites, brick kilns & others (river islands, isolated populations) They may be covered by mobile or hth teams (use format 4 D for planning) Conduct house to house activity in these areas from day 1 itself Construction sites and brick kilns have to be visited twice because of frequent migration
56

Cold chain and logistics Microplans

57

Estimate Vaccine Requirement

OPV doses requirement per round = No. of target children x 1.27 (vaccine wastage factor) OPV vials required = OPV doses required 20
(rounded off to next higher whole figure)

 Plan for storage of vaccine at district and block level cold chain equipment  Plan for vaccine movement from district to block to teams
58

Assess cold chain at District / PHC

Power supply? Cold chain equipment maintained and in order? Temperature monitoring inside DF/ILR? Plan for freezing of ice packs in DF/ Alternate freezing plans in ice factories? Stacking of ice packs in deep freezer? VVM status of OPV vials stocked for NIDs? Plan for reuse of partially used vials after checking VVM? Plan for distribution of vaccine and logistics including vehicle deployment developed?
59

Name of the Area

Total Check lists Chalk/ Geru

Plan for procurement & distribution of logistics

Use Logistics & Transport planning form 3

Logistics for Supervisors

P sweep tally sheet

Reporting formats

Vaccinator tally sheets

OPV vial openers

Other logistics

Indelible ink marker pen Aprons for transit point team members only Armbands/ Identity cards

60

Review Transport Plans

Use Logistics & Transport planning form 3

Has transport been planned for:

Supervisors, supply of vaccine and logistics, Miking, Mobile teams?

Availability of Govt. vehicles assessed? Shortfall assessed and hiring planned? Types of vehicles required determined?
Two wheelers/three wheelers/jeep/car, rickshaws, ferry/boats, animals, .etc.

Is there a route chart for every vehicle?

61

IEC/Social Mobilization Preparedness (1) Plan for Miking/drum beating (use form 5)
Preparation of audio cassettes in local language Plan for route chart for miking/drum beating utilizing slow moving vehicles Plan for miking from religious and other fixed sites Should be before and during the activity

Plan for utilization of local cable network

62

IEC/Social Mobilization Preparedness (2)

Plans for rallies by school children Plan for preparation distribution and display of Posters/ Handbills/ Banners Plan for involvement of all Panchayati Raj, local influencers, community and religious leaders Plan for programme launch Plan for involving local press media release press conference,

63

Summary: Micro planning issues

Ensure sufficient booths to cover all areas - specially high risk areas Maximum involvement of manpower from ICDS/ASHA/Other Govt. departments for booth, house -to-house, transit & mobile teams Ensure all high risk areas are included in microplans for coverage and are supervised by SPHOs/Programme Officers Ensure teams to cover all prominent transit & special sites
64

Planning Trainings
Develop a training plan in the district IPPI workshop cluster level
S. No Date of session Venue No of expected participants Name of trainer

Complete all trainings including catch up sessions 2-3 days before SIA activity Decentralize training venues to increase attendance - sessions at PHCs/ Community centres etc Batch size should not exceed 40 50 participants; 40 in HRAs also in corporations/municipalities) Cluster level Officers & District Programme Officers to attend training sessions for supervision & quality Catch up sessions if attendance is poor 65

Training Attendance
Ensuring attendance shall be the key responsibility of the MO/SPHO/ DIO Fix sessions & send timely information to all concerned Some tips for improving attendance
Written communication to vaccinators from Govt. through respective departments MOs to convey written communication to vaccinators from voluntary sector A list of vaccinators with their address & contact telephone numbers helps in improving attendance SMS reminders

Ensure information reaches all Insist on signed counterfoil of training information slip
66

Quality trainings for vaccinators & supervisors

Use training module (IPPI Guide 2006 pg 58-66) plan innovations, keep trainings participative
 Role plays : How to enter houses and initiate dialogue & FAQs  Exercises on vaccine administration, Tally sheet filling, house marking  Demonstration of VVM, Finger marking

Train transit/ mobile teams separately Supervisors should be trained separately on specific responsibilities Monitor and track training attendance give feedback in DTF (District Task Force Meeting)/MTF (Mandal Task Force Meeting)
67

Feedback of trainings

68

69

70

Organize Mandal /Urban Task Force Meetings for interintersectoral coordination

Mandal / Urban Task Forces to be established under the chairmanship of Commissioner/MDO/MRO Participants: CMOH, AMOs, SPHOs, APVVPSuperintendent, Medical Officers, Officials from ICDS, Education, Revenue, Panchayati Raj Institutions, local NGOs & community leaders MTF shall also meet regularly to:
Review progress Ensure completeness and timely implementation of activities

Role of district administration:

Participate in MTFs, bring up issues of coordination like manpower deployment, transport etc for discussion Ensure meetings are organized twice before the round and minutes prepared for follow up actions

71

Supervisory plans
Develop supervisory / monitoring plans for
SPHOs / PHC / CHC MOs District level health officials District/ Mandal administration officers. Supervisory / Monitoring plans by state officers

Plans for evening feed back meetings/ recording & reporting Plans for monitoring & feedback by independent monitors by partners
72

Organize Evening Feedback Meetings & Ensure Timely Corrective Actions

PHC/CHC Medical Officer to organize daily evening meetings with supervisors and monitors along with other participating departments During evening meeting give direct feedback to Supervisors & MOs on
Areas not covered well Areas with coordination problems Areas with operational problems and Discuss and ensure mid- course corrections thus solve problems seen in field

If > 3 False Ps are detected by a monitor / supervisor, the activity has to be repeated in the area of the concerned team.
73

Validation of high risk areas

74

Timeline of activities for High risk area validation

State NID work shop
20/01/12

Completion of high risk sites identification & Districts to identify manpower for validation
By 24/01/12

Training of identified manpower

25/01/12

Process of validation - high risk area identified

From 27/01 31/01/12

Compilation of validated data at cluster level

01 & 02/02/12

Compilation of validated data at District level

04 & 05/02/12

Information to be shared in DTF / MTF / UTF

Report to State
06/02/12 75

NIDs 2012: Key Actions

During NIDs ensure very high coverage in high risk areas because these are the areas at maximum risk Following NIDs, strengthen implementation of Routine Immunization in High risk areas Maintain high levels of AFP Surveillance sensitivity to detect any WPV importations
76